Gkika E, Tanadini-Lang S, Kirste S, Holzner P A, Neeff H P, Rischke H C, Reese T, Lohaus F, Duma M N, Dieckmann K, Semrau R, Stockinger M, Imhoff D, Kremers N, Häfner M F, Andratschke N, Nestle U, Grosu A L, Guckenberger M, Brunner T B
Department of Radiation Oncology, Medical Center - University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg im Breisgau, Germany.
Department of Radiation Oncology, University Hospital Zürich, Zurich, Switzerland.
Strahlenther Onkol. 2017 Oct;193(10):823-830. doi: 10.1007/s00066-017-1177-y. Epub 2017 Jul 10.
Definition of gross tumor volume (GTV) in hepatocellular carcinoma (HCC) requires dedicated imaging in multiple contrast medium phases. The aim of this study was to evaluate the interobserver agreement (IOA) in gross tumor delineation of HCC in a multicenter panel.
The analysis was performed within the "Stereotactic Radiotherapy" working group of the German Society for Radiation Oncology (DEGRO). The GTVs of three anonymized HCC cases were delineated by 16 physicians from nine centers using multiphasic CT scans. In the first case the tumor was well defined. The second patient had multifocal HCC (one conglomerate and one peripheral tumor) and was previously treated with transarterial chemoembolization (TACE). The peripheral lesion was adjacent to the previous TACE site. The last patient had an extensive HCC with a portal vein thrombosis (PVT) and an inhomogeneous liver parenchyma due to cirrhosis. The IOA was evaluated according to Landis and Koch.
The IOA for the first case was excellent (kappa: 0.85); for the second case moderate (kappa: 0.48) for the peripheral tumor and substantial (kappa: 0.73) for the conglomerate. In the case of the peripheral tumor the inconsistency is most likely explained by the necrotic tumor cavity after TACE caudal to the viable tumor. In the last case the IOA was fair, with a kappa of 0.34, with significant heterogeneity concerning the borders of the tumor and the PVT.
The IOA was very good among the cases were the tumor was well defined. In complex cases, where the tumor did not show the typical characteristics, or in cases with Lipiodol (Guerbet, Paris, France) deposits, IOA agreement was compromised.
肝细胞癌（HCC）中大体肿瘤体积（GTV）的定义需要在多个造影剂期进行专门成像。本研究的目的是评估多中心专家组在HCC大体肿瘤勾画中的观察者间一致性（IOA）。
分析在德国放射肿瘤学会（DEGRO）的“立体定向放射治疗”工作组内进行。来自9个中心的16名医生使用多期CT扫描对3例匿名HCC病例的GTV进行了勾画。在第一个病例中，肿瘤边界清晰。第二个患者有多灶性HCC（一个融合灶和一个周边肿瘤），之前接受过经动脉化疗栓塞术（TACE）。周边病变与先前的TACE部位相邻。最后一名患者患有广泛的HCC，伴有门静脉血栓形成（PVT），且由于肝硬化肝实质不均匀。根据Landis和Koch评估IOA。
第一个病例的IOA为优秀（kappa值：0.85）；第二个病例中，周边肿瘤的IOA为中等（kappa值：0.48），融合灶的IOA为实质性（kappa值：0.73）。对于周边肿瘤，不一致最可能是由TACE后位于存活肿瘤尾侧的坏死肿瘤腔所致。在最后一个病例中，IOA为中等，kappa值为0.34，肿瘤和PVT边界存在显著异质性。
在肿瘤边界清晰的病例中，IOA非常好。在肿瘤未表现出典型特征的复杂病例或有碘油（法国巴黎Guerbet公司）沉积的病例中，IOA一致性受到影响。
